Mun-Keat Looi

Europe lacks the ability to track and deal with recurring severe shortages of medicines, which reached record levels in 2024, warns a report by the European Court of Auditors.1It found that European Union countries ran critically short of 136 medicines from January 2022 to October 2024. Furthermore, when faced with these rising shortages many countries began to stockpile medicines, which worsened shortages in other countries, the report said.Although the European Medicines Agency (EMA) tries to reduce the impact of shortages, the auditors noted that there was still no effective …

US President Donald Trump has said that the painkiller Tylenol (acetaminophen; paracetamol in the UK) could contribute to autism in children and has urged pregnant women to avoid it.In a White House announcement on 22 September1 he advised pregnant women to steer clear of the drug or to use it sparingly, “if you can’t tough it out.”2Acetaminophen is considered the standard option for treating fever and pain in pregnancy in both the US3 and UK.The UK Medicines and Healthcare Products Regulatory Agency (MHRA) says the drug has the most favourable safety profile in pregnancy among commonly used painkillers. Alternatives, such as non-steroidal anti-inflammatory drugs, pose higher risks in later pregnancy.4The US medical community reacted to Trump’s announcement with scepticism.The American College of Obstetrics and Gynecologists said, “Acetaminophen is one of the few options available to pregnant women to treat pain and fever, which can be harmful when left untreated.”Steven Fleischman, president of the college, said, “The claim is not backed by the full body of scientific evidence and dangerously simplifies the many and complex causes of neurologic challenges in children.“Studies that have been conducted in the past show no clear evidence that proves a direct relation between the prudent use of acetaminophen during any trimester and fetal developmental problems.”5In the White House announcement, the US administration also endorsed the drug leucovorin, often used by patients with cancer, for treating cerebral folate deficiency (CFD), a rare condition …

Gaza, Ukraine, and Sudan have put a spotlight on attacks on healthcare facilities and staff in conflict zones. The BMJ looks at the data, which seem to show a new strategy of war: removing civilians’ access to careThe number of military and other hostile attacks on healthcare infrastructure and staff in many of the world’s major conflict zones has risen markedly in the past five years. Data for 2020 to the end of 2024 from the Attacks on Health Care in Countries in Conflict dataset (box 1) show that the number of attacks has nearly tripled overall (fig 1), with the conflicts in Ukraine and Gaza boosting numbers of attacks and the resulting deaths and injuries (table 1).Box 1 ### Data used by The BMJWe used the Attacks on Health Care in Countries in Conflict (SHCC) dataset,1 which contains agency sourced and open source events included in the annual reporting by the Safeguarding Health in Conflict Coalition (SHCC) on violence against or obstruction of healthcare.The dataset is hosted by the Humanitarian Data Exchange of the UN Office for the Coordination of Humanitarian Affairs (OCHA).All data are for 2020 to 2024 (data for 2025 have not yet been published).Data for the Palestinian territories occupied by Israel are for both Gaza and the West Bank, including East Jerusalem.RETURN TO TEXTFig 1 Attacks on healthcare (2020-24). An interactive version of this graphic and downloadable data are available at https://public.flourish.studio/visualisation/25553533View this table:Table 1 Attacks on healthcare facilities and associated deaths and injuries, in selected conflicts (2020-24)“This is a very disturbing trend, and it’s a product of the types of wars we’re seeing right now,” says Len Rubenstein, professor and director of the Program on Human Rights and Health in Conflict at Johns Hopkins Bloomberg School of Public Health, Baltimore, in response to the data.“It’s a five year trend, …

The former head of the international vaccine access organisation Gavi tells The BMJ about the politicising of vaccination, chaos at the CDC, and the impact on global vaccine equity### BiographySeth Berkley is a US physician and infectious disease epidemiologist trained at Brown and Harvard Universities. After completing residency in internal medicine in Boston he joined the Special Pathogens Branch of the US Centers for Disease Control and Prevention (CDC) and worked on vaccine and HIV/AIDS programmes in Uganda. He later led the Rockefeller Foundation’s vaccine work, founded the International AIDS Vaccine Initiative, and served as chief executive of Gavi, the Vaccine Alliance (2011-23). He co-created Covax (Covid-19 Vaccines Global Access) during the covid pandemic to ensure that vaccines reached all countries that needed them. He is now adjunct professor and senior adviser at Brown University’s Pandemic Center and an adviser to numerous technology companies.### The BMJ: Misinformation and disinformation have destabilised societies and put a major dent in people’s trust in vaccines. How did this happen?SB: We’ve always seen vaccine hesitancy. But this time it’s different because it’s become highly politicised, and disinformation was coming not just from a subgroup of people—whether that be church leaders or a group that socially didn’t like something—but it’s becoming policy in countries. That’s a real problem because, for the institutions that are trying to deal with the misinformation that’s there, they’re now being challenged by their own leaders.The second thing, of course, is that misinformation and particularly disinformation now can spread literally at the speed of light because of social media. That’s a real problem when you’re trying to get good information out: you’re overwhelmed by the systems that are putting out this bad information. And the challenge of disinformation now is the massive number of bots from different countries putting it out. There are mixed messages being put out, and that makes it very hard going forward.The challenge is, how do …

England’s chief medical officer said in a recent lecture that misinformation has always accompanied medical progress—and that the battle is winnable if we can talk honestly about uncertainty“Through every single one of the past 160 years there was extensive misinformation about health—and yet the improvements continued,” said Chris Whitty, chief medical officer for England. “It is extremely important that we take on this misinformation, but we also should accept that this is a battle that is winnable.”Whitty was speaking at Health Misinformation: Unpacked, an event held in October at the London School of Hygiene and Tropical Medicine, at which Whitty is also professor of public and international health.He reminded the audience that public health has advanced despite resistance—from smallpox vaccination to sanitation—and argued that the current moment is not uniquely perilous.Whitty also challenged the notion that the UK is experiencing a collapse in vaccination confidence. “People who are peddling disinformation often try to give the impression that the public is split down the middle. That is untrue,” …

The former CDC director tells The BMJ why he’s optimistic despite the chaos at his former agency and why primary care—and AI—matter for clinicians### BiographyTom Frieden is an internist and infectious disease physician who served as director of the US Centers for Disease Control and Prevention from 2009 to 2017. He was previously New York City’s health commissioner and is now president and chief executive of Resolve to Save Lives, a non-profit global health organisation. His new book, The Formula for Better Health ,1 is published by MIT Press.Certainly for the US, the most deadly error was poor communication during the first Trump administration. In 2020 there was chaotic communication, denial, and the silencing of the CDC [Centers for Disease Control and Prevention], which was not allowed to speak after it provided fact based, clear information. And even in the Biden administration you had a tremendous increase in distrust of the CDC.The essence of good crisis communication is to tell people what you know—and tell them what you don’t know. Start every recommendation with the phrase, “Based on what we know now.” Tell people how you learned what you know, how you’re trying to find out more, and when you’re likely to know it.Measures to silence people are really problematic. For example, when the so called Great Barrington Declaration2 came out, saying let’s just let …

Access to mifepristone for medical abortion in the US through telehealth, pharmacies, and mail order remains after the US Supreme Court extended a temporary order for a second time on 11 May. The extension gives the justices until at least 14 May to decide whether to allow sweeping new restrictions to take effect across the country.The full court is now weighing whether to uphold a 1 May ruling by the 5th US Circuit Court of Appeals that would require patients to obtain the drug in person at a clinic rather than through a pharmacy or mail order—a change that would apply in every state, including those where abortion is …